Provider Demographics
NPI:1710183009
Name:DIXON, TATIANA KATHARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:KATHARINA
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1855 W TAYLOR ST
Mailing Address - Street 2:MC 648, RM 2.42
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7242
Mailing Address - Country:US
Mailing Address - Phone:312-996-6584
Mailing Address - Fax:312-996-1282
Practice Address - Street 1:1855 W TAYLOR ST
Practice Address - Street 2:MC 648, RM 2.42
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7242
Practice Address - Country:US
Practice Address - Phone:312-996-6584
Practice Address - Fax:312-996-1282
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.129673207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology